{
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"FirstLineMailingAddress": "126 E FAIRGROUND ST",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "740-619-7015",
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"EnumerationDate": "01/09/2019",
"LastUpdateDate": "01/08/2026",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CARR",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "740-751-4761",
"Taxonomies": {
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"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}